Ultrarapid Insulin Use Can Reduce Postprandial Hyperglycemia and Late Hypoglycemia, Even in Delayed Insulin Injections: A Connected Insulin Cap-Based Real-World Study

• Published in: Diabetes technology & therapeutics Vol. 26; no. 1; p. 1
• Main Authors: Gómez-Peralta, Fernando, Valledor, Xoan, López-Picado, Amanda, Abreu, Cristina, Fernández-Rubio, Elsa, Cotovad, Laura, Pujante, Pedro, García-Fernández, Elena, Azriel, Sharona, Corcoy, Rosa, Pérez-González, Jesús, Ruiz-Valdepeñas, Luis
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: Late postprandial hypoglycemia; Postprandial hyperglycemia; Ultrarapid insulin; Connected insulin pen cap
• ISSN: 1557-8593
• DOI: 10.1089/dia.2023.0321

Reaching optimal postprandial glucose dynamics is a daily challenge for people with type 1 diabetes (T1D). This study aimed to analyze the postprandial hyperglycemic excursion (PHEs) and late postprandial hypoglycemia (LPH) risk according to prandial insulin time and type. Real-world, retrospective study in T1D using multiple daily injections (MDI) analyzing 5 h of paired continuous glucose monitoring and insulin injections data collected from the connected cap . Meal events were identified using the rate of change detection methodology. Postprandial glucometrics and LPH (glucose <70 mg/dL 2-5 h after a meal) were evaluated according to insulin injection time and rapid (RI) or ultrarapid analog, Fiasp (URI), use. Meal glycemic excursions (  = 2488), RI: 1211, 48.7%; UR: 1277, 51.3%, in 82 people were analyzed according to injection time around the PHE: -45 to -15 min; -15 to 0 min; and 0 to +45 min. In 63% of the meals, insulin was injected after the PHE started. Lower PHE was observed with URI versus RI (glucose peak-baseline; mg/dL; mean ± standard deviation): 106.7 ± 35.2 versus 111.2 ± 40.3 (  = 0.003), particularly in 0/+45 injections: 111.6 ± 40.2 versus 118.1 ± 43.3; (  = 0.002). One third (29.1%) of participants added a second (correction) injection. The use of URI and avoiding a second injection were independently associated with less LPH risk, even in delayed injections (0/+45), (-36%, odds ratio [OR] 0.641; confidence interval [CI]: 0.462-0.909;  = 0.012) and -56% (OR 0.641; CI: 0.462-0.909  = 0.038), respectively. URI analog use as prandial insulin reduces postprandial hyper- and hypoglycemia, even in delayed injections.